Women In Entertainment (WIE) Mentorship Mentee Application

Contact Information

Please note that all information received is confidential and becomes the property of Big Brothers Big Sisters of Greater Los Angeles. Big Brothers Big Sisters does not discriminate on the basis of race, ethnicity, sexual orientation, religion, or physical ability. Parent/Guardian approval will be required to submit application.

Referral Source

Please specify/name

Parent/Guardian Information

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Gender

How do you identify?

Cell Phone

Home Phone

Work Phone

Parent/Guardian Preferred Phone

Parent/Guardian Best Time to Call

Parent/Guardian Personal Email

Parent/Guardian Contact Preference

Parent/Guardian Street Address

City

State

Zip Code

Parent/Guardian Employment Information (optional)

Parent/Guardian Employment Status

Parent/Guardian Employer

Employer Address Line 1

Employer Address Line 2

Employer City

Employer State

Employer Zip Code

Custody Information

Do you have legal custody of this student child?

YesNo

Does anyone share custody of this student child?

YesNo

How often does the student child see his/her other custodial parent/guardian?

WeeklyMonthlyOther

Other

Does the student child's other custodial parent/guardian know you are applying for a Big Brother/Sister?

YesNo

Family Doctor Information

Family Doctor Name

Family Doctor Phone

Family Doctor Address

Student Allergies

Type N/A if none

Emergency Contact Information

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Emergency Contact Relationship to Student

Mentee Contact ID

UpdatedContact ID

CreatedContact ID

Mentee Application ID

UpdatedApplication ID

CreatedApplication ID

Essay Questions

Instructions for Essays:
Answer the questions below individually. Feel free to express yourself openly. There's no specific word count, but please provide detailed answers. Use your unique voice and writing style. Let's get to know you better!

1. Tell us your story. What should we know about your background, your values, and what makes you unique?

2. What is one major challenge you've faced - personally, academically, or at home? How did you grow and what did you learn from it?

3. What are your future goals - in school and in your career? What kind of college or career path are you hoping to pursue, and why?

4. Are there any personal responsibilities, time commitments, or challenges that might make it difficult to fully participate in the program? If so, how can we support you?

High School Transcript

Upload Unofficial Transcript

GPA

Letter of Recommendation

Provide the name and contact information for the person who will submit a letter of recommendation on your behalf. They will be contacted directly by a staff member at Big Brothers Big Sisters of Los Angeles.

First Name

Last Name

Email

Parent/Guardian Consent

I, the undersigned parent/legal guardian of the below-named child, hereby give permission for my child to apply for and participate in the program listed above.

I authorize the sponsoring organization to collect, review, and use my child’s personal information as necessary for the purpose of evaluating their application and participation in the program. This may include, but is not limited to:

Application materials
Academic or performance records
Personal statements or essays
Supporting documents provided during the application process

I further authorize the sponsoring organization to share my child’s application and related information with partner organizations, reviewers, selection committees, and affiliated agencies involved in the review, evaluation, and selection process.

These partners will use the information solely for purposes related to the program and will maintain appropriate confidentiality.

I understand that reasonable measures will be taken to protect my child’s information. However, I acknowledge that information shared with partner organizations will be handled in accordance with their respective privacy practices.

I have read this Agreement completely. I fully understand what it means, and I agree to its terms.

I Agree

Student Full Name

Parent/Guardian's Full Name

Today's Date

American Indian or Alaska Native	Asian - Chinese
Asian - Filipino	Asian - Indian
Asian - Japanese	Asian - Korean
Asian - Other	Asian - Vietnamese
Black or African American	Hispanic - Cuban
Hispanic - Mexican,Mexican American,Chicano	Hispanic - Other Latinx or Spanish origin
Hispanic - Puerto Rican	Middle Eastern or North African
Pacific Islander - Chamorro	Pacific Islander - Native Hawaiian
Pacific Islander - Other	Pacific Islander - Samoan
White or Caucasian	Other
Prefer not to say

English	Spanish
African Languages (Swahili, Bantu)	American Sign Language
Arabic	Asian: Other
Chinese	Creole
Dutch	Eastern European (Czech, Slovak)
French	German
Greek	Hebrew
Hmong	Indian (Hindi, Punjabi)
Italian	Japanese
Keres (West)	Korean
Nordic	Persian
Portuguese	Russian
Turkish	Lao